U.S. patent number 8,971,501 [Application Number 12/422,561] was granted by the patent office on 2015-03-03 for methods and systems to identify code hierarchy bias in medical priority dispatch systems.
This patent grant is currently assigned to Priority Dispatch Corporation. The grantee listed for this patent is Jeffrey J. Clawson, Richard M. Saalsaa. Invention is credited to Jeffrey J. Clawson, Richard M. Saalsaa.
United States Patent |
8,971,501 |
Clawson , et al. |
March 3, 2015 |
Methods and systems to identify code hierarchy bias in medical
priority dispatch systems
Abstract
A system and method assists an emergency medical dispatcher in
responding to emergency calls by generating a determinant level
code. A computer implemented method to determine Code Hierarchy
Bias generates a determinant level sub-code that can be stored and
analyzed with the determinant level code to determine the nature of
Code Hierarchy Bias, to reveal hidden signs, symptoms, and
conditions, to improve the accuracy and usefulness of determinant
level codes, and to tailor emergency medical response structure for
a more efficient use of emergency response personnel and
resources.
Inventors: |
Clawson; Jeffrey J. (Salt Lake
City, UT), Saalsaa; Richard M. (Salt Lake City, UT) |
Applicant: |
Name |
City |
State |
Country |
Type |
Clawson; Jeffrey J.
Saalsaa; Richard M. |
Salt Lake City
Salt Lake City |
UT
UT |
US
US |
|
|
Assignee: |
Priority Dispatch Corporation
(Salt Lake City, UT)
|
Family
ID: |
42934413 |
Appl.
No.: |
12/422,561 |
Filed: |
April 13, 2009 |
Prior Publication Data
|
|
|
|
Document
Identifier |
Publication Date |
|
US 20100260325 A1 |
Oct 14, 2010 |
|
Current U.S.
Class: |
379/45;
379/38 |
Current CPC
Class: |
G16H
40/20 (20180101); G16H 10/20 (20180101) |
Current International
Class: |
H04M
11/04 (20060101) |
Field of
Search: |
;379/37,38,45,49,265.01
;455/404,404.2,457,404.1,521,415 ;705/1.1,2,3,325
;340/539.12,539.13 ;607/5,60 ;700/108 |
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Primary Examiner: Teshale; Akelaw
Attorney, Agent or Firm: Thompson; John R. Stoel Rives
LLP
Claims
What is claimed is:
1. A computer-implemented method to improve the clinical accuracy
of determinant level codes generated by medical priority dispatch
systems, the method comprising: receiving at the computer system,
from a medical priority dispatch system, one or more reported
aspects collected from a caller who responds to questions asked by
the dispatcher over a telephone, wherein the questions are provided
to the dispatcher by the medical priority dispatch system and the
reported aspects are relating to an emergency reported by the
caller and are each one of the following: a sign, a symptom, and a
condition; receiving at a computer system, from a medical priority
dispatch system, a determinant level code selected by a dispatcher
utilizing the medical priority dispatch system, the determinant
level code representing a subset of the reported aspects;
generating on the computer system a determinant level sub-code and
pairing it with the determinant level code, wherein the determinant
level sub-code is generated by the computer system based on the one
or more reported aspects and represents a combination of all of the
one or more caller reported aspects; comparing on the computer
system the determinant level code and determinant level sub-code
pair to other determinant level code and determinant level sub-code
pairs to identify whether a situation involving the reported
aspects is susceptible to introducing code hierarchy bias; and
outputting from the computer system information resulting from the
comparison of determinant level code and determinant level sub-code
pairs that enables improvements to the clinical accuracy of the
determinant level codes generated by the medical priority dispatch
system.
2. The computer-implemented method of claim 1, wherein the reported
aspects include at least one of signs, symptoms, and
conditions.
3. The computer-implemented method of claim 1, wherein comparing
further comprises comparing determinant level code and determinant
level sub-code pairs having the same determinant level
sub-code.
4. The computer-implemented method of claim 1, further comprising
storing the determinant level sub-code and the determinant level
code in a non-transitory computer-readable storage medium.
5. The computer-implemented method of claim 1, wherein the
determinant level sub-code is generated by selecting, from a list
of sub-codes, a sub-code that represents the combination of all of
the one or more caller reported aspects, wherein the list of
sub-codes comprises possible combinations of aspects that may be
reported by the caller in responses to the protocol questions.
6. The computer-implemented method of claim 1, further comprising
storing the determinant level code and the corresponding reported
aspects collected from the caller in a non-transitory
computer-readable storage medium, wherein the computer system
retrieves the determinant level code and the corresponding reported
aspects and generates the determinant level sub-code.
7. A computer-implemented method for enabling evaluation and
research of code hierarchy bias in medical priority dispatch
systems, the method comprising: receiving, at a medical priority
dispatch computer system, caller responses to questions provided by
the medical priority dispatch system, the responses reporting one
or more signs, symptoms, or conditions relating to an emergency
reported by the caller; generating a determinant level code based
on the caller responses and relaying the determinant level code to
emergency responders, the determinant level code representing a
subset of the caller-reported signs, symptoms, or conditions
relating to the emergency; generating, at the medical priority
dispatch computer system, a determinant level sub-code based on the
caller responses by selecting a sub-code representing a combination
of all of the caller-reported signs, symptoms, and conditions, the
sub-code selected from a list of sub-codes representing potential
combinations of signs, symptoms, and conditions that can be
reported in the caller responses; and the medical priority dispatch
system storing the determinant level sub-code in combination with
the determinant level code in a non-transitory computer-readable
storage medium.
8. The computer-implemented method of claim 7, further comprising
storing the caller responses in a non-transitory computer-readable
storage medium for subsequent examination to generate the
determinant level sub-code.
9. The computer-implemented method of claim 7, further comprising
the medical priority dispatch computer system comparing determinant
level code and determinant level sub-code pairs to identify whether
a combination of reported aspects in a given situation is
susceptible to code hierarchy bias.
10. The computer-implemented method of claim 9, wherein the medical
priority dispatch computer system comparing further comprises
comparing determinant level code and determinant level sub-code
pairs having the same determinant level sub-code.
11. The computer-implemented method of claim 7, further comprising
performing statistical analysis on a plurality of stored
determinant level code and sub-code combinations to determine
situations that are susceptible to code hierarchy bias.
12. The computer-implemented method of claim 7, further comprising
performing statistical analysis on a plurality of stored
determinant level code and sub-code combinations to determine a
clinical make-up of the determinant level code as it relates to
specific situations and diagnoses and to ensure the determinant
level codes are medically accurate.
13. A computer-implemented method for emergency medical dispatch
response, the method comprising: receiving at a computer system
caller responses to questions asked by a dispatcher, the responses
reporting aspects, including signs, symptoms, or conditions,
relating to an emergency, wherein the responses are input into the
computer system by the dispatcher, and wherein the questions are
provided to the dispatcher according to a pre-scripted protocol by
a medical priority dispatch system running on the computer system;
the computer system and dispatcher generating a determinant level
code indicative of the criticality of the call based on the caller
responses, the determinant level code representing a subset of the
caller-reported aspects relating to the emergency; the computer
system generating a determinant level sub-code based on a
combination of signs, symptoms, and conditions reported in the
caller responses to the protocol questions, the sub code
representing the combination of all of the reported signs,
symptoms, and conditions; the computer system storing the
determinant level code and the determinant level sub-code pair; and
the computer system communicating to an emergency response agency
the determinant level code and determinant level sub-code.
14. The computer-implemented method of claim 13, further comprising
the computer system storing the caller responses on a
non-transitory computer-readable storage medium for subsequent
examination to generate the determinant level sub-code, wherein the
computer system generates the determinant level sub-code by
electronically searching and analyzing the caller responses to
generate the determinant level sub-code.
15. The computer-implemented method of claim 13, further comprising
the computer system performing statistical analysis on stored
determinant level code and sub-code data to determine situations
that are susceptible to code hierarchy bias.
16. The computer-implemented method of claim 13, further comprising
the computer system performing statistical analysis on stored
determinant level code and sub-code descriptor data to determine a
clinical make-up of each determinant level code as it relates to
specific situations and diagnoses and to ensure the determinant
level codes are medically accurate.
17. A computer system for identifying code hierarchy bias in a
medical priority dispatch system, the computer system comprising: a
medical priority dispatch system to generate a determinant level
code indicative of the criticality of the call based on caller
responses to questions asked by a dispatcher, wherein the questions
are provided to the dispatcher according to a pre-scripted protocol
by the medical priority dispatch system, and wherein the responses
report a plurality of aspects and the determinant level code
represents a subset of the plurality of aspects, each aspect of the
plurality of aspects comprising one of the following: a sign, a
symptom, a condition; a code hierarchy system in communication with
the medical priority dispatch system, the code hierarchy system
configured to receive the determinant level code generated on the
medical priority dispatch system, to generate a determinant level
sub-code based on a combination of aspects reported in the caller
responses to the questions asked by the dispatcher, to store the
determinant level code and the determinant level sub-code pair; and
communicate to an emergency response agency the determinant level
code and determinant level sub-code, wherein the determinant level
sub-code represents the combination of all reported aspects,
wherein the computer system compares the determinant level code and
determinant level sub-code pair to other determinant level code and
determinant level sub-code pairs to identify whether a combination
of reported aspects of a situation is susceptible to code hierarchy
bias and outputs information resulting from the comparison of
determinant level code and determinant level sub-code pairs that
can be used to improve the clinical accuracy of the determinant
level codes generated by the medical priority dispatch system.
18. The computer system of claim 17, wherein the computer system
compares the determinant level code and determinant level sub-code
pair to other pairs by performing statistical analysis to identify
situations susceptible to code hierarchy bias.
19. The computer system of claim 17, wherein the medical priority
dispatch system is on a first computer and the code hierarchy
system is on a second computer, and wherein the computer system
further comprises a network to enable communication between the
first computer and the second computer.
20. A computer system for identifying code hierarchy bias in
medical priority dispatch systems, the computer system comprising:
a processor; an output device; an input device; a memory having
stored thereon: pre-scripted inquiries to be directed to an
emergency caller by a dispatcher utilizing the computer system;
pre-scripted instructions to be provided to an emergency caller by
the dispatcher; a protocol module configured to present, on the
monitor, the pre-scripted inquiries and instructions to the
dispatcher; and a calculator module configured to determine a
determinant level code and a determinant level sub-code based on
caller responses to the pre-scripted inquiries, wherein the caller
responses report aspects, including signs, symptoms, and
conditions, wherein the determinant level code represents a subset
of the reported signs, symptoms, and conditions, and wherein the
determinant level sub-code represents an entire combination of all
the signs, symptoms, and conditions that are reported in the caller
responses.
21. A computer system of claim 20, wherein the memory further
comprises caller responses received from one or more callers
responding to the pre-scripted inquiries, wherein the caller
responses are stored on the memory to be subsequently searched and
analyzed.
22. A computer system of claim 20, wherein the memory further
comprises stored determinant level code and stored determinant
level sub-codes.
Description
TECHNICAL FIELD
This invention relates to computer systems and methods that provide
medical protocol interrogation and instructions for emergency
dispatch. More specifically, the invention is directed to systems
and computer implemented methods to improve such emergency medical
dispatch systems and methods.
BRIEF DESCRIPTION OF THE DRAWINGS
Non-limiting and non-exhaustive embodiments of the disclosure are
described, including various embodiments of the disclosure with
reference to the figures, in which:
FIG. 1 depicts a block diagram of one embodiment of a system to
identify code hierarchy bias in a medical priority dispatch
system.
FIG. 1A depicts a block diagram of another embodiment of a system
to identify code hierarchy bias in a medical priority dispatch
system.
FIG. 2 depicts a display of one embodiment of a medical priority
dispatch system.
FIGS. 3A-3C depict a display of another embodiment of a medical
priority dispatch system and illustrate stack Code Hierarchy
Bias.
FIGS. 4A-4C depict a display of the embodiment of a medical
priority dispatch system of FIGS. 3A-3C and illustrate dual Code
Hierarchy Bias.
FIG. 5 depicts a flowchart of one embodiment of a method to
determine Code Hierarchy Bias in a medical priority dispatch
system.
FIG. 6 depicts a flowchart of another embodiment of a method to
determine Code Hierarchy Bias in a medical priority dispatch
system.
FIG. 7 depicts a list of determinant level code and determinant
level sub-code combinations that may be output by one embodiment of
a method to identify Code Hierarchy Bias in a medical priority
dispatch system.
DETAILED DESCRIPTION
Thousands of calls requesting emergency medical services are made
every year. Many of these calls are not true medical emergencies
and some medical emergencies have higher priority than others, so
it is important to prioritize the calls in several ways. For
example, true emergency calls with the highest priority should be
dispatched first. Moreover, if a response agency has units with
different capabilities, the more severe medical problems should
receive the more advanced units. Finally, if lights-and-siren are
not needed from a medical standpoint, they should not be used,
thereby increasing the safety of all those on the road and in the
emergency vehicles.
An automated medical priority dispatch system ("MPDS") may aid a
call taker, or emergency medical dispatcher ("EMD"), in
prioritizing the calls. The MPDS may follow a protocol comprising a
logic tree that provides the EMD with pre-scripted inquiries or
questions to be directed to a caller, that presents potential
responses from the caller, and that provides the EMD with
instructions for the caller based on the responses of the caller.
The pre-scripted inquiries may ask or prompt the caller to report
aspects of the emergency situation being reported. Aspects of the
emergency situation may include but are not limited to signs,
symptoms, and conditions. The aspects may relate to the patient,
the circumstances at the time of the incident, and the
circumstances present as the call is proceeding. As can be
appreciated, symptoms may relate primarily to a patient, whereas
signs and conditions may relate to a patient or to circumstances
surrounding the incident.
The caller responses may route to subsequent pre-scripted inquiries
and/or instructions to the caller. The caller responses may be
processed by the MPDS according to predetermined logic to generate
a consistent and predictable dispatch response. In this manner, the
MPDS also aids the EMD to provide both the correct emergency
medical dispatch response and the appropriate doctor-approved
post-dispatch instructions to the caller before professional help
arrives. Exemplary embodiments of such medical dispatch systems and
protocols are disclosed in U.S. Pat. Nos. 5,857,966, 5,989,187,
6,004,266, 6,010,451, 6,053,864, 6,076,065, 6,078,894, 6,106,459,
6,607,481, 7,106,835, and 7,428,301, which are incorporated herein
by reference.
The MPDS can aid the EMD in categorizing and prioritizing emergency
calls by generating a determinant level code that categorizes the
type and level of the incident. The determinant level code may
include an emergency type descriptor for the type of incident or
situation, an emergency level descriptor indicating priority, and a
determinant value. For example, a determinant level code "6-D-1"
comprises an emergency type descriptor `6,` an emergency level
descriptor `D`, and a determinant value `1.` The emergency type 6
indicates breathing problems. The emergency level D indicates that
the response level is Delta. Some examples of possible emergency
levels are C (for lowest level emergencies requiring a response
level of Charlie), D (for mid-level emergencies requiring a
response level of Delta), and E (for highest level emergencies
requiring a response level of Echo). An emergency level descriptor
and determinant value may be referred to together as a determinant.
The MPDS may include a determinant calculator to calculate a
determinant from the caller's responses to protocol questions. The
determinant calculator may calculate the determinant by assigning a
value to each aspect of a situation that may be reported in a
caller response according to the clinical criticality of the
aspect. In another embodiment, a calculator may simply calculate
the determinant value. In still another embodiment, a calculator
may calculate the determinant level code by calculating the
determinant and then combining the determinant with the emergency
type descriptor.
The determinant level code enables the EMD to dispatch an
appropriate emergency response agency, such as police, fire
department, paramedics, etc., to the scene of the emergency. The
determinant level code also may be communicated to the response
agency to aid in anticipating the type of response and resources
needed for the particular emergency at the scene. Because the
questions asked and the recommendations made may deal directly with
life and death decisions, it is important for the protocol and/or
the EMD to determine the correct determinant level code.
A commonly recurring challenge to generating a correct determinant
level code for a situation arises when a caller or patient reports
more than one aspect of a given situation, each of which may be
similarly critical. When multiple aspects are reported that are
similarly critical, the EMD and/or the MPDS may then be forced to
make a choice that can affect how the protocol of the MPDS
proceeds. Although aspects may be similarly critical, the aspects
may be ranked hierarchically according to their clinical
importance. The clinical importance may be derived from how
critical or life threatening the aspect is from a clinical
standpoint. Accordingly, a choice to focus on one aspect of the
situation likely may result in generation of a determinant level
code that is different than would be generated by another
choice.
When the caller reports multiple similarly critical aspects, the
MPDS may be programmed to pick a choice, or prompt the EMD to make
a choice, based on the aspect with the highest ranking criticality.
Even if the MPDS were not programmed to pick or prompt for a
choice, the EMD may make his or her own subjective comparison of
the reported aspects and choose based on perceived criticality. The
choice recommended by the MPDS and/or made by the EMD introduces
what may be referred to as Code Hierarchy Bias. Code Hierarchy Bias
can be described as the tendency of MPDS logic, or an EMD, to make
a particular choice when presented with a set of similarly critical
aspects of an emergency situation. The emergency dispatch system
industry does not currently realize this bias exists, and presently
there are no means for determining the nature of the bias or how
the bias may affect emergency dispatch.
Understanding how Code Hierarchy Bias affects emergency dispatch
requires understanding the nature of the bias. Stated differently,
it requires understanding why MPDS logic and/or a human EMD may
select a particular determinant level code when multiple similarly
critical aspects, such as signs, symptoms, or conditions, are
concurrently present. Unfortunately, understanding the `why` is not
easy because the choices made are not presently trackable. Multiple
reported aspects can result in cloaking of one or more of the
reported signs, symptoms, or conditions, no matter the specific
choice made.
The nature of emergency dispatch simply does not lend itself to
capturing every reported aspect. As an example, the MPDS protocol
may be designed to identify the most critical situations,
inherently keying on the most critical aspects reported. Keying on
the critical aspects can lead to filtering and generalizing a
situation rather than distinguishing and detailing the situation.
In other words, a determinant level code may merely approximate or
partially describe a clinical presentation in a given emergency
situation. Furthermore, an EMD may be primarily focused on rapid
processing of the call, more intent on achieving a rapid response
than an providing an accurate response. These characteristics,
inherent to emergency dispatch, result in failure to gather data
that can be used to determine whether the MPDS protocol facilitates
correct emergency responses and how the MPDS and underlying
protocol can be improved.
The present disclosure attempts to address these challenges by
providing methods and systems for capturing and revealing the
multiple reported aspects of emergency situations that may be
cloaked or hidden by present emergency call processing, and thereby
reveal the nature of Code Hierarchy Bias. An automated
computer-implemented method according to the present disclosure,
operating in association with an MPDS, can facilitate revealing
Code Hierarchy Bias. Revealing Code Hierarchy Bias can enhance the
ability, through scientific studies, to unlock hidden or overlooked
conditions, to improve the accuracy and usefulness of determinant
level code descriptors, and to tailor the Emergency Medical System
response structure.
The embodiments of the disclosure will be best understood by
reference to the drawings, wherein like elements are designated by
like numerals throughout. In the following description, numerous
specific details are provided for a thorough understanding of the
embodiments described herein. However, those of skill in the art
will recognize that one or more of the specific details may be
omitted, or other methods, components, or materials may be used. In
some cases, operations are not shown or described in detail.
Furthermore, the described features, operations, or characteristics
may be combined in any suitable manner in one or more embodiments.
It will also be readily understood that the order of the steps or
actions of the methods described in connection with the embodiments
disclosed may be changed as would be apparent to those skilled in
the art. Thus, any order in the drawings or Detailed Description is
for illustrative purposes only and is not meant to imply a required
order, unless specified to require an order.
Embodiments may include various steps, which may be embodied in
machine-executable instructions to be executed by a general-purpose
or special-purpose computer (or other electronic device).
Alternatively, the steps may be performed by hardware components
that include specific logic for performing the steps or by a
combination of hardware, software, and/or firmware.
Embodiments may also be provided as a computer program product
including a computer-readable storage medium having stored thereon
instructions that may be used to program a computer (or other
electronic device) to perform processes described herein. The
computer-readable storage medium may comprise a memory device,
including but not limited to, hard drives, floppy diskettes,
optical disks, USB drives, CD-ROMs, DVD-ROMs, ROMs, RAMs, EPROMs,
EEPROMs, magnetic or optical cards, solid-state memory devices, or
other types of media/machine-readable medium suitable for storing
electronic instructions. For example, instructions for performing
described processes may be transferred from a remote computer
(e.g., a server) to a requesting computer (e.g., a client) by way
of data signals via a communication link (e.g., network
connection).
Several aspects of the embodiments described will be illustrated as
software modules or components. As used herein, a software module
or component may include any type of computer instruction or
computer-executable code located within a memory device and/or
transmitted as electronic signals over a system bus or wired or
wireless network. A software module may, for instance, comprise one
or more physical or logical blocks of computer instructions, which
may be organized as a routine, program, object, component, data
structure, etc., that performs one or more tasks or implements
particular abstract data types.
In certain embodiments, a particular software module may comprise
disparate instructions stored in different locations of a memory
device, which together implement the described functionality of the
module. Indeed, a module may comprise a single instruction or many
instructions, and may be distributed over several different code
segments, among different programs, and across several memory
devices. Some embodiments may be practiced in a distributed
computing environment where tasks are performed by a remote
processing device linked through a communications network. In a
distributed computing environment, software modules may be located
in local and/or remote memory storage devices. In addition, data
being tied or rendered together in a database record may be
resident in the same memory device, or across several memory
devices, and may be linked together in fields of a record in a
database across a network.
FIG. 1 depicts a block diagram of one embodiment of a computer
system 100 to identify code hierarchy bias in an emergency medical
dispatch system. The computer system 100 may comprise a computer
101 having a processor 102 coupled to input/output (I/O) and memory
106. The memory 106 may comprise a computer-readable storage
medium. The memory 106 may include components of a medical priority
dispatch system ("MPDS"), including a protocol module 108 to aid an
emergency medical dispatcher (EMD) 126 in processing an emergency
call, pre-scripted inquiries 110 and pre-scripted instructions 112
that the protocol module 108 can present to the EMD 126 by way of
the computer monitor 124 or other display, and a determinant value
calculator module 116 that determines an appropriate determinant
value and/or determinant level code based on the caller responses
114 to the pre-scripted inquiries 110. The determinant value
calculator module 116 of the memory 106 may further comprise a
determinant level sub-code calculator to calculate a determinant
level sub-code that can be used to identify Code Hierarchy Bias, as
will be described in greater detail. The memory 106 may further
include storage for caller responses 114 to the pre-scripted
inquiries 110. The memory 106 may store pre-established determinant
level codes 118 and determinant level sub-codes 120 from which the
appropriate output coding 122 can be derived and stored. The
determinant level codes 118 and the determinant level sub-codes may
be stored as pairs, or otherwise associated together.
An emergency caller 130 can dial 9-1-1 to reach the local Emergency
Medical System to seek assistance for an emergency situation
involving a patient 134. The caller 130 can be connected to an EMD
126 over a voice communication network 132. The protocol module 108
is initiated to aid the EMD 126 in processing the call. The
protocol module 108 can be initiated automatically by the MPDS as
part of the call being received by the EMD 126. In another
embodiment, the EMD 126 can initiate the protocol module 108, for
example, by clicking a button on a graphical user interface
displayed on the monitor 124. The protocol module 108 presents the
EMD 126 with pre-scripted inquiries 110 and/or pre-scripted
instructions 112 to be directed by the EMD 126 to the caller 130.
The EMD 126 may read the pre-scripted questions 110 and/or
instructions 112 to the caller 130 over the voice communication
network 132.
The EMD 126 receives responses to the questions from the caller
130. The questions guide the caller 130 to gather information about
the patient 134. As the caller responds to the questions, the
information about the patient 134 is relayed by the caller 130 to
the EMD 126 over the communication network 132. The EMD 126 inputs
the caller responses into the MPDS using the keyboard 123 and/or a
user interface displayed on the monitor 124. The caller responses
114 are stored in the memory 106. The processor 102 can process the
caller responses to provide information that the protocol module
108 can use to determine how to proceed. The processor 102 can also
process the responses to determine one or more candidate
determinant level codes 118 and one or more determinant level
sub-codes 120 that capture all the aspects of the situation
reported by the caller 130 in the caller's responses 114 to the
pre-scripted inquiries 110.
FIG. 1A depicts a block diagram of another embodiment of a computer
system 150 to identify code hierarchy bias in an emergency medical
dispatch system. The computer system 150 comprises a code hierarchy
system 152, which may include a processor 154 and a memory 156. The
memory may store determinant level sub-codes 158. The memory may
further comprise a determinant level sub-code calculator 160 and
storage for information received from an MPDS, such as caller
responses 162 and determinant level codes 164. The code hierarchy
system 152 interfaces with or is coupled to an MPDS 166. The MPDS
may comprise a computer having a processor, input and output
devices, and a memory having components such as a protocol module,
pre-scripted inquiries, pre-scripted instructions, and a
determinant value calculator module as described above with
reference to FIG. 1. As can be appreciated, the embodiment of the
computer system 150 of FIG. 2 may comprise a single computer. In
another embodiment, the computer system 150 may comprise a first
computer for the MPDS 166 and a second computer for the code
hierarchy system 152 coupled together via a network.
An EMD 126 using the MPDS 166 can receive an emergency medical call
from a caller 130, via a network 132, and can process the call
according to a protocol of the MPDS 166. While the call is being
processed, the MPDS 166 provides the EMD 126 with pre-scripted
inquiries or questions and instructions for the caller 130, as
previously described with reference to FIG. 1. The EMD 126 enters
caller responses to the inquiries or questions about a patient 134
into the MPDS 166 and the MPDS 166 generates a determinant level
code based on those caller responses.
The code hierarchy system 152 can receive the caller responses 162
and determinant level codes 164 from the MPDS 166. The caller
responses 162 and determinant level codes 164 may be stored in the
memory 156. The sub-code calculator module 160 can use the
determinant level codes 164 and/or caller responses 162 to
calculate a determinant level sub-code 158 to be output or stored.
The determinant level codes and sub-codes can then be used to
determine Code Hierarchy Bias.
FIG. 2 depicts a display of one embodiment of a display 200 of an
MPDS traversing a protocol. The MPDS is at a point in the protocol
where a determinant level code may be determined and selected. The
display 200 is an output screen of a software program that
implements a MPDS. The display 200 is shown when the MPDS is at a
point in the protocol after multiple questions have been asked by
the EMD and answered by the caller and a determinant level code is
being determined by the EMD and/or the MPDS. The display 200 may
comprise a clock 202 displaying the current time, a protocol
indicator 204 signaling to an EMD the protocol the MPDS is
currently following, an Answers pane 206, a determinant level code
Send button 208, a display 210 on the Send button 208 to show the
currently selected determinant level code, a Determinants pane 220,
and a Response Level pane 118.
The protocol indicator 204, as shown in FIG. 2, indicates that the
current protocol of the MPDS is Protocol 6, which guides an EMD in
handling "Breathing Problems" related calls. Accordingly, the
Determinants pane 220 displays a list of determinants 222 that can
aid in categorizing and/or prioritizing the variations of breathing
problems the patient may be experiencing. The determinants 222
comprise an emergency level descriptor and a determinant value. A
brief description of what each determinant represents is also
included in the Determinants pane 220.
The EMD directs inquiries or questions to the caller to identify
the aspects of the patient's breathing problem. The caller's
responses are entered into the MPDS to enable the MPDS to identify
candidate determinants 222 to highlight in the Determinants pane
220. From the candidate determinants 222, the MPDS and/or the EMD
can determine an appropriate determinant level code to send to the
emergency response agency. The currently recommended (or EMD
selected) determinant 222 may be highlighted by a selection cursor
223 in the Determinants pane 220. Other determinants 222 can match
the symptoms, and thereby qualify as selection candidates that the
EMD or the MPDS may select. These selection candidates can also be
highlighted, for example in a different color, or otherwise
indicated. In one embodiment, the EMD may select a candidate
determinant 222 and thereby override a recommended MPDS
selection.
The Answers pane 206 displays answers provided by the caller in
response to questions generated by the MPDS protocol. The responses
may be typed in by the EMD, or the field may be populated according
to selections made by the EMD in another user interface. In one
embodiment the Answers pane 206 may display all of the current
caller's responses. In another embodiment, merely select caller
responses may be displayed, such as those responses that trigger a
higher determinant as a candidate. In still another embodiment,
only the most recent caller responses are displayed. The caller
responses may be numbered in the Answers pane 206. In FIG. 2,
caller response 1 indicates the patient "is able to talk" and
caller response 2 indicates the patient "is not changing color."
Based on caller responses 1 and 2, the display 210 on the Send
button 108 shows that the MPDS and/or the EMD has determined, thus
far, that the proper determinant is "C-1 Abnormal breathing." A
selection cursor 223 highlights the currently selected determinant
in the Determinants pane 220.
In another embodiment, the lowest level determinant may be
automatically selected as a default until a caller response
triggers selecting a different determinant. The embodiment shown in
FIG. 2 may be initially highlighting C-1 as a default determinant,
although it may be the case that neither of the two responses
received to this point would have triggered the C-1 determinant. In
another embodiment, no determinant is selected until a caller
response corresponds to a determinant.
The Response level for determinant C-1, as indicated in the
Response Level pane 118, is Charlie. The Response level may be
described as a higher level categorization of the situation, and
may correspond to, and signal to the response agency, the level of
emergency response needed. The response level can correspond to the
emergency level descriptor of the corresponding determinant
222.
FIGS. 3A-4C aid in understanding Code Hierarchy Bias and the
challenge addressed by the present invention. When multiple aspects
of a situation are present and reported by a caller, the inherent
nature of emergency medical dispatch introduces a potential for
bias. The MPDS protocol generally may be designed and configured to
identify the most critical situations by keying on the most
critical aspects reported, and thereby filter and generalize
emergency situations. Protocol 6, as depicted on the protocol
indicator 304 in FIGS. 3A-3C and the protocol indicator 404 in
FIGS. 4A-4C, is useful to demonstrate this filtering and
generalizing, and the bias that may result.
FIGS. 3A-3C depict a display of another embodiment of a medical
priority dispatch system. These figures illustrate a first type of
bias, a stack bias, which is encountered when two or more aspects,
including but not limited to signs, symptoms, or conditions,
correspond to a defined determinant level code descriptor, as is
the case with 6-D-1 Severe Respiratory Distress ("SRD"). Two
aspects may trigger selection of the 6-D-1 SRD determinant level
code: (1) the patient may be changing color, or (2) the patient may
have difficulty speaking between breaths. If only the determinant
level code is used and/or communicated, at times the actual nature
of the problem being reported may be masked because it may be
unclear which condition triggered the determinant. With two trigger
aspects, there are three different medical situations covered by
the 6-D-1 determinant level code descriptor, namely the patient may
be suffering with either aspect, or with both aspects. More
specifically, the patient could (i) be changing color, only, (ii)
have difficulty speaking between breaths, only, or (iii) be
changing color and have difficulty speaking between breaths. Thus,
there is uncertainty as to which of the three is the exact
situation when only the 6-D-1 code is communicated and/or
recorded.
In FIG. 3A, the problem being reported is SRD due to `difficulty
speaking between breaths.` Based on responses 1-5 in the Answers
pane 306, the display 310 on the Send button 308 in FIG. 3A shows
that the MPDS and/or the EMD has determined the proper code to be
sent is 6-D-1 for SRD. Specifically, response 2 in the Answers pane
306 indicates the EMD operating the MPDS is speaking to a caller
that is reporting a patient manifesting difficulty speaking between
breaths. The determinant D-1 is highlighted by the selection cursor
323 in the Determinants pane 320 to show it is currently selected.
If only the determinant level code 6-D-1 is communicated to the
emergency response agency, there is no way for the agency to
determine that the response was triggered by "difficulty speaking
between breaths" as opposed to "changing color." Further, if only
6-D-1 is recorded for subsequent research and analysis, there is no
way to go back and determine which aspect(s) triggered the
determinant. Even if the responses are also recorded, performing
subsequent research and analysis on the data requires tediously
reviewing each series of questions and caller responses and
counting, or identifying the combination of, the aspects reported.
Such tedious review is impractical and approaches impossible when
the number of calls and cases to be analyzed is in the millions and
when the total number of possible question and answer combinations
currently exceeds 83 million.
In FIG. 3B, the problem being reported is also SRD, but this time
the aspect being reported is that the patient is `changing color`
(rather than difficulty speaking between breaths). Based on
responses 1-5 in the Answers pane 306, the display 310 on the Send
button 308 in FIG. 3B shows that the MPDS and/or the EMD has
determined the proper code to be sent is again 6-D-1 for SRD.
Specifically, response 4 in the Answers pane 306 indicates the EMD
operating the MPDS is speaking to a caller that is reporting a
patient who is changing color, but who is not having difficulty
speaking between breaths. The determinant D-1 is highlighted by the
selection cursor 323 in the Determinants pane 320 to show it is
currently selected. Again, if only the determinant level code 6-D-1
is communicated to the emergency response agency, or recorded for
research purposes, there is no way to determine that the response
was triggered by a patient who is changing color rather than who is
having difficulty speaking between breaths.
In FIG. 3C, the problem being reported is again SRD, and this time
both of the aspects of the determinant level code 6-D-1 are being
reported. Based on the caller responses 1-5 in the Answers pane
306, the display 310 on the Send button 308 in FIG. 3C shows that
the MPDS and/or the EMD has determined the proper determinant level
code to be used is again 6-D-1 for SRD. Specifically, responses 2
and 4 in the Answers pane 306 indicate the EMD operating the MPDS
is speaking to a caller that is reporting a patient manifesting
both difficulty speaking between breaths and changing color. The
determinant D-1 is highlighted by the selection cursor 323 in the
Determinants pane 320 to show it is currently selected. Again, if
only the determinant level code 6-D-1 is sent to the emergency
response agency, or recorded for research purposes, there is no way
to determine that the response was triggered by a patient who is
manifesting both aspects included in the clinical definition of
severe respiratory distress, rather than simply one or the
other.
FIGS. 4A-4C depict a display of another embodiment of a medical
priority dispatch system and illustrate another type of bias. This
second type of Code Hierarchy Bias, a dual code bias, is
encountered when the aspects, including but not limited to signs,
symptoms, or conditions, of more than one determinant level code
descriptor are present. For example, the signs and symptoms
represented by determinant level codes "6-D-2 Not alert" or "6-D-3
Clammy" may also be present in a "6-D-1 SRD" coded patient. The
signs and symptoms of these lower priority codes are hidden by the
selection and sending of determinant level code "6-D-1."
In FIG. 4A, the problem being reported is again severe respiratory
distress. However, the aspect of being "not alert" (which can be a
factor for selecting the "D-2 Not Alert" determinant) is present in
addition to the aspect of changing color, which triggers the "D-1
SRD" determinant. Based on responses 1-5 in the Answers pane 406,
the MPDS and/or the EMD may have determined the proper determinant
level code to be sent is again "6-D-1 SRD." Specifically, responses
3 and 4 in the Answers pane 406 indicate the EMD operating the MPDS
is speaking to a caller that is reporting a patient who is not
alert and who is changing color. The determinant D-1 is highlighted
by the selection cursor 423 in the Determinants pane 420 to show it
is currently selected. Again, if only the determinant level code
6-D-1 is sent to the emergency response agency, or recorded for
research purposes, there is no way for the agency to determine that
the patient is also manifesting the aspect of not being alert that
triggers the second determinant D-2. Thus, dual code bias is
introduced.
The MPDS of FIGS. 4A-4C, however, implements one embodiment of a
method of the present disclosure to aid in identifying both stack
and dual code bias. Specifically, in one embodiment of the present
disclosure, an automated computer system and/or
computer-implemented method operate in association with the MPDS to
generate a determinant level sub-code based on a caller's
responses. The determinant level sub-code represents a combination
of reported aspects. For example, in FIG. 4A the display 410 on the
Send button 408 indicates the determinant level code, and appends a
determinant level sub-code, in this case "t". The sub-code "t"
represents the combination of aspects `changing color` AND `not
alert.` Including the sub-code "t" allows quick identification of
all the aspects that were reported. The emergency response agency
has more information available. Moreover, if the sub-code is
recorded with the determinant level code, analysis can subsequently
be performed to identify Code Hierarchy Bias and to assess the
accuracy and usefulness of the determinant level code in
communicating different emergency situations.
In FIG. 4B, the problem being reported manifests the same aspects
as FIG. 4A above, namely changing color and not alert. In this case
the MPDS and/or the EMD may have determined the proper determinant
level code to be sent is "6-D-2 Not Alert." In another embodiment,
the EMD may have overridden the MPDS determination. The determinant
level D-1 SRD is highlighted as a candidate, but not currently
selected. Rather the determinant D-2 Not Alert is highlighted by
the selection cursor 423 in the Determinants pane 420 to show it is
currently selected. If only the code 6-D-2 is sent to the emergency
response agency, or recorded for research purposes, there is no way
to determine that the patient is also manifesting the aspect of
changing color. Nor is there any way to go back and investigate why
the EMD or MPDS may have selected 6-D-2, or why the EMD may have
overridden the system recommendation of sending 6-D-1, because
there would be no record of the reported aspect of changing
color.
The methods of the present disclosure capture more information, and
thereby enable discovery of the nature of the bias. In addition to
the determinant level code 6-D-2, the determinant level sub-code
"t" is appended. As before, the sub-code "t" represents the
combination of both aspects reported, `changing color` AND `not
alert.` The sub-code "t" provides more information for identifying
Code Hierarchy Bias and for improving the system.
FIG. 4C depicts a final example. In FIG. 4C, the patient is
manifesting the same aspects as FIG. 4A above (changing color and
not alert) and is also "clammy." Based on responses 1-5 in the
Answers pane 406, the display 410 on the Send button 408 in FIG. 4C
shows that the MPDS and/or the EMD has determined the proper
determinant level code to be sent is again 6-D-1. Specifically,
responses 3, 4, and 5 in the Answers pane 406 indicate the EMD
operating the MPDS is speaking to a caller that is reporting a
patient who is not alert, changing color, and clammy. The
determinant D-1 SRD is highlighted by the selection cursor 423 in
the Determinants pane 420 to show it is currently selected. Again,
if only the determinant level code 6-D-1 is sent to the emergency
response agency, or recorded for research purposes, there is no way
for the agency to determine that the patient is also manifesting
the aspects of not being alert and clammy. However, the display 410
on the Send button 408 indicates both the determinant level code
and a determinant level sub-code "z". The sub-code "z" represents
the combination of aspects `changing color` AND `not alert` AND
`clammy.` By generating a determinant level sub-code, the methods
of the present disclosure capture and reveal more information, and
enable discovery of the nature of any Code Hierarchy Bias that may
be present.
One of ordinary skill in the art will readily recognize that the
determinant level sub-code may be generated a variety of ways. In
one embodiment, the method of the present invention may generate
the determinant level sub-code concurrently, while the MPDS
proceeds through a protocol. In another embodiment, the method may
store the caller responses and subsequently search and analyze the
stored caller responses after the determinant level code is
determined. In still another embodiment, the method may search and
analyze the stored caller responses after the determinant level
code has been sent to the emergency response agency.
FIG. 5 depicts a flow chart of one embodiment of a method 500 to
determine Code Hierarchy Bias. The method 500 receives data from a
MPDS, and generates a determinant level sub-code from the data
received. The determinant level sub-code may be output. The method
may start and may run concurrently while the MPDS traverses a
protocol. Response data is collected 510 from caller responses to
questions 52 generated by the MPDS protocol. The determinant level
code 54 may also be received 512 from the MPDS protocol. The method
500 also may access 514 a file containing determinant level
sub-codes 516. The determinant level sub-code can be calculated
based on the caller response data received 510. The determinant
level code and sub-code are combined and output 518 for
transmission to the emergency response agency and/or storage. The
method then ends. The output may be subsequently examined,
analyzed, and/or compared with other output to similar cases to
identify and reduce Code Hierarchy Bias and to improve the MPDS
system or coding structure.
In another embodiment, the method 500 may run asynchronously with
the MPDS, perhaps long after the MPDS has traversed the
corresponding protocol. Response data is collected 510 from caller
responses to questions 52 generated by the MPDS protocol. The
responses may be collected 510 real-time from the MPDS, or may be
retrieved from storage where they were previously recorded and
fixed. Likewise, the determinant level code descriptor may be
received real-time from the MPDS, or may be retrieved from storage
where it was previously recorded and fixed. The output of the
method 500 may be subsequently examined, analyzed, and/or compared
with other output to similar cases to identify and reduce Code
Hierarchy Bias and to improve the MPDS system or coding structure.
For example, a determinant level code and determinant level
sub-code pair may be compared to other determinant level code and
determinant level sub-code pairs having the same determinant level
sub-code. Because the determinant level sub-codes are identical,
the same aspects were reported in each situation and the comparison
can indicate the type of situations that are susceptible to Code
Hierarchy Bias.
FIG. 6 depicts a flow chart of another embodiment of a method 600
to determine Code Hierarchy Bias. This method may comprise steps
generally performed by an MPDS. For example, the method 600 may
generate 608 key questions to display to an EMD according to a
protocol. The responses to the questions are collected 610 and
then, similar to an MPDS, the data may be used to generate 612 a
determinant level code that can be used to determine an appropriate
emergency response to dispatch 66. The determinant level code can
also be sent 68 to an emergency response agency. With response data
and a determinant level code descriptor, an appropriate determinant
level sub-code may be determined 615 and then output 616 with the
determinant level code. The determinant level sub-code can also be
sent 68 with the determinant level code to the response agency. In
another embodiment, the method 600 can be incorporated into an MPDS
protocol.
FIG. 7 depicts a list of potential combinations 702 of a
determinant level code 704 and determinant level sub-codes 706 that
may be output by one embodiment of a method to determine Code
Hierarchy Bias in a MPDS. A description 708 is included for
convenience in interpreting the combinations 702. As is apparent,
the sub-codes 706 allow for creation of variations of the
determinant level code 704. In this case, the determinant level
code 704 is 6-D-1 and the potential combinations created with
varying sub-codes 706 are shown. The various combinations 702
convey information that may otherwise not be generated or conveyed
without the present invention. The list demonstrates that there are
at least 12 possible clinical situations that may be included in
what may have previously been a single code, namely determinant
level code 6-D-1. That there are at least 12 possible combinations
702 illustrates the risk that an MPDS is cloaking signs, symptoms,
and/or conditions and suggests the difficulty of revealing Code
Hierarchy Bias without the embodiments of present disclosure.
Various modifications, changes, and variations apparent to those of
skill in the art may be made in the arrangement, operation, and
details of the methods and systems of the disclosure without
departing from the spirit and scope of the disclosure. Thus, it is
to be understood that the embodiments described above have been
presented by way of example, and not limitation, and that the
invention is defined by the appended claims.
* * * * *
References